Critical assessment of the current experience of the Veneto cancer Registry (RTV) on the regional dataflow of neoplastic pathology records (ANAPAT), based on the NAP-coding.

Materials and methods

In the Veneto Public Heath Care System, cancer registration is regulated by a regional law (3/2013), which formally establishes an “information debt” of all the regional (both private, and public) healthcare institutions involved in the histological cancer assessment (i.e.: network of the Regional Pathology Departments [NRPD]). Cancer registration is basically settled on the collection of the pathology reports, as produced by the NRPD. The pathology reports are automatically transmitted (every six months) from the NRPD to a Regional Center of data collection (DWH). The collected data (always including Topography and Morphology) are coded according to NAP (Nomenclatore Anatomia Patologica), which has been implemented (year 2017) in all the Pathology Departments of the Regional Heath Care System. Each report includes 3 sections: i) demographics; ii) cancer biology/profile (topography/morphology); iii) textual health data. The NAP-coding includes about 25000 codes: 6185 topographic codes (based on the third SNOMED-edition; 3885 neoplastic morphologies (based on the 2005 edition of ICD-O-3, with multiple equivalent lexical variants); 490 procedure codes; 3171 qualifiers (including the TNM staging codes).

Results

Twice a year, the pathology reports are (automatically) uploaded in a regional portal for management of health sources (DWH), where a pre-fixed series of logical-formal checks is automatically performed (e.g.: presence of the required variables, values’ consistency, keys’ integrity). The regional-DWH automatically produces checking-reports of any occurring error/discrepancy; this first-level report is automatically delivered to the sending Health-care Institution. After data amendment, the “cleansed-files” are resubmitted to DWH. In a subsequent step, data are checked /managed by the Regional Cancer Registry (RTV). A second-level-checking is performed by the RTV-staff, focusing on both qualitative (e.g.: distribution of exams by year, month and diagnostic type) and quantitative (e.g.: misalignments and/or inconsistencies between Topography and Morphology; generic NAS codes; records without topographic code, records with non-tumour morphology [not M8-M9], etc). In a final step, any inconsistent record is returned to NRPD, for a critical conclusive reassessment and a conclusive download in the regional portal.

Conclusions

In 2017, about 55% of the reports entered into the RTV having the data transcoded from NAP to ICDO-3 and ICD-9; the remaining cases mainly consist of non-malignant pathology (e.g.: lipomas, nevi or polyps). Currently, the lines of further development on the ANAPAT dataflow are: i) anonymization and archiving in the regional DWH; ii) developing more extensive interaction with other regional Institutions involved in the clinical organization, monitoring, and in the efficiency/efficacy improvement of the Veneto Oncology network (calculation of indicators of diagnostic-therapeutic pathways); iii) implementation of the “text mining” for clinical variables (cancer stage, molecular profiling).